| NPI | 1306334289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0019681) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2025030498) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2025-08-05 |